Tumor lysis syndrome Regarding a clinical case.

Abstract

Introduction: Tumor lysis syndrome (TLS) is a potentially fatal complication of cancer caused by the rapid and massive destruction of neoplastic cells, which leads to hyperphosphatemia, hyperkalemia, and hyperuricemia. These imbalances can cause serious complications, such as cardiac arrhythmias, renal failure, and a high risk of death.

Case presentation: An 18-year-old male with a history of Hodgkin lymphoma in the anterior mediastinum was admitted to the intensive care unit (ICU) with acute respiratory failure after undergoing two previous chemotherapy sessions. He required advanced airway management and invasive mechanical ventilation, along with vasopressor support using norepinephrine due to shock and low blood pressure. A large pleural effusion was diagnosed, necessitating chest tube placement.

Clinical course: In the ICU, he received another chemotherapy session, which caused further hemodynamic instability. Paraclinical tests revealed elevated blood urea nitrogen (BUN) and electrolyte disturbances, including a significant rise in phosphorus and uric acid levels. According to the Cairo-Bishop grading criteria, a grade 2 tumor lysis syndrome was diagnosed.

Therapeutic Management: Hemodiafiltration was performed. The patient showed steady improvement after three sessions, with recovery of renal function.